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New Haven EPESE, 1982-1991

Carlos F. Mendes de Leon, PhD; Harlan M. Krumholz, MD; Teresa S. Seeman, PhD; Viola Vaccarino, MD, PhD; Christianna S. Williams, MPH; Stanislav V. Kasl, PhD; Lisa F. Berkman, PhD

Arch Intern Med. 1998;158:2341-2348.

Background  Results of several recent studies suggest that depression is predictive of incident coronary disease. However, few studies have examined this relationship in the elderly, the age at which most coronary heart disease (CHD) becomes clinically manifest.

Methods and Results  Data are from the New Haven, Conn, cohort (N=2812) of the Established Populations for the Epidemiologic Studies of the Elderly project. Baseline information on depressive symptoms and CHD risk factors was collected during an in-person interview in 1982. Nonfatal myocardial infarctions were identified through monitoring of admissions to local hospitals and were validated by medical chart review. Cause of death was obtained from death certificates for all deceased participants. Outcomes were defined as CHD deaths (n=255) and total incident CHD events (n=391) between January 1, 1982, and December 31, 1991. There was no association between depressive symptoms and CHD outcomes in men. Among women, depressive symptoms were associated with an age-adjusted relative risk of 1.03 (per unit increase on the symptom scale) for CHD mortality (P=.001) and total CHD incidence (P=.002). These associations were largely unaffected by adjustment for established CHD risk factors but were reduced to nonsignificant levels after additional adjustment for impaired physical function. Additional analysis showed a significant association for depressive symptoms among women who had no physical function impairments or who survived at least 3 years without an event.

Conclusion  Depressive symptoms may not be independent risk factors for CHD outcomes in elderly populations in general but may increase risk among relatively healthy older women.

From the Rush Institute for Healthy Aging, Rush-Presbyterian-St Luke's Medical Center, Chicago, Ill (Dr Mendes de Leon); the Section of Cardiovascular Medicine (Dr Krumholz) and the Department of Epidemiology and Public Health (Drs Vaccarino and Kasl and Ms Williams), Yale University School of Medicine, New Haven, Conn; the Ethel Percy Andrus Gerontology Center, University of Southern California, Los Angeles (Dr Seeman); and the Departments of Health and Social Behavior and Epidemiology, Harvard School of Public Health, Boston, Mass (Dr Berkman).

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